Provider Demographics
NPI:1427447952
Name:THIEL, JENNIFER REBECCA (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:REBECCA
Last Name:THIEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 WESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715-5674
Mailing Address - Country:US
Mailing Address - Phone:352-931-0767
Mailing Address - Fax:844-551-0739
Practice Address - Street 1:719 WESTVIEW DR
Practice Address - Street 2:
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-5674
Practice Address - Country:US
Practice Address - Phone:352-931-0767
Practice Address - Fax:844-551-0739
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9495967363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9495967OtherFL NP LICENSE
FLRN9495967OtherFL RN LICENSE